Contractures, a tendency for muscles, tendons or scar tissue to shorten in skeletal joints, are common after trauma and represent a major challenge in the care of such injuries. Routine and occupational tasks can be severely hindered by flexion-extension contractures of the humeral-ulnar joint as well as supination-pronation contractures of the proximal radial-ulnar joint which controls rotational motion of the radius about the axis of the ulna.
Current approaches to the treatment of elbow trauma have more aggressively sought to prevent contracture and stiffness through movement. Methods of rigid internal fixation with sufficient stability to allow motion within days after injury rather than closed treatment and immobilization in a cast have been developed. In the treatment of dislocations, protected early motion is now begun as soon as the patient is comfortably able to do so.
However, the currently available techniques for the prevention of contracture are not uniformly successful. Early active motion alone can reduce the severity of contracture, but requires the patient's own strength, compliance and constant effort. Passive stretching by a therapist can be done on a very limited basis and it is applied slowly, but such therapy risks the formation of heterotopic bone and myositis ossifications. Dynamic splints may be used, but these require pressure on the sometimes sensitive or injured soft tissues of the arm and forearm and thus may reduce patient compliance, or may not be possible to use, i.e., in burn injury.
Additionally, fractures of the proximal radius that require distraction have been treated in the past with simple pin fixation holding the ulna fixed to the radius. While fixed to the ulna, contracture and loss of motion occur.
Recently, a device was developed which permits aligned flexion and extension of the elbow during fixation to treat or prevent flexion-extension contracture at this joint. See U.S. Pat. No. 5,102,411. However, no known device is available to prevent or correct supination-pronation contracture at the elbow joint.
It would be highly desirable to provide a mechanical device for the prevention or correction of contracture of the proximal radial-ulnar joint controlling the motions of pronation and supination. It would be further desirable to provide a device which permits distraction of fractures of the radial-ulnar joint as well as motion to optimize control of the fracture and permit motion during healing, thereby reducing the tendency for contracture and loss of motion.